Frontiers2018-11-27T01:51:34Zhttp://frontiersmag.wustl.edu/feed/atom/WordPressDili Chenhttp://frontiersmag.wustl.edu/?p=23072018-11-11T04:54:51Z2018-10-23T07:17:03ZThe problem of gun violence in the US is deeply complex and especially serious among developed nations in the world. Despite being declared as a major public health issue in 1989 by the American Medical Association Council on Scientific Affairs, gun violence has received remarkably little attention from researchers, due to political controversy and lack of federal funding. Most notably, the 1996 Dicky Amendment prohibited the use of federal funding to the National Center for Injury Prevention and Control for advocating or promoting gun control. Between 2004 to 2015, gun violence research had only less than two percent of the predicted funding and less than five percent of the predicted publication volume, given its mortality rates (1). A review of the current literature on gun policies found that most studies have major methodological weaknesses or inconsistent evidence on the effects of various categories of gun policies on the firearm industry, firearm usage, and firearm fatalities (2). Thus, current discourse on gun violence is severely limited by a weak evidence base and lack of reliable datasets, which prevent the development of evidence-based interventions for gun violence in the U.S.

Gun violence is a serious health problem in the US. Compared to other developed countries, the overall firearm death rate and gun homicide rate are ten and approximately twenty-five times higher in the US, respectively (3). Among young adults, the gun homicide rate is forty-nine times higher in the US, compared to twenty-three other developed countries (3). In particular, gun murder rates for young black men are estimated to be nearly 20 times the national average (16). Although gun violence predominantly affects young black males, the disparity exists throughout the lifespan. Sadly, firearm deaths and injuries in the US are preventable, unjust, and disproportionately affect black populations.

(Clockwise from top left) Small businesses on Dr. Martin Luther King Dr; an abandoned building on Natural Bridge Ave; a bench at a MetroBus stop on cracked and uneven tarmac; a church on Natural Bridge Ave.

In St. Louis City, an overwhelming proportion of homicides are committed with firearms. Despite accounting for less than half of the population, black Americans bear burden of gun violence. Based on data reported by the St. Louis Metropolitan Police Department, gun violence is concentrated to several neighborhoods in North St. Louis, including Wells-Goodfellow, Walnut Park East, Mark Twain, and Jeff-Vander-Lou (6). These neighborhoods consist largely of black populations with high school education levels and household incomes of less than ten thousand dollars (4,5). Unemployment levels in these neighborhoods are also over four times that of the state or national average (5). Clearly, gun violence is affecting our most disadvantaged communities in St. Louis.

The health impacts of gun violence are long-lasting and pervasive. Other than death, firearm-related injuries are associated with disability, chronic stress, post-traumatic stress disorder (PTSD), injury recidivism, aggression, sleep disturbance, withdrawal, and erosion of social cohesion. Young children, in particular, are more susceptible to the long-term harms of gun violence exposure. Based on the National Survey of Adolescents, higher levels of exposure to violence in children is the strongest predictor of PTSD, and is also associated with more behavioural problems and reduced academic achievement.

Since violence exposure is associated with various negative health impacts, it would be expected that the similar impacts extend to health professionals who are indirectly exposed to violence in caring for victims of gun violence. According to the Medscape Physician Lifestyle Report in 2017, emergency medicine saw the highest and greatest increase in proportion of physicians reporting burnout among the twenty-seven specialties surveyed, compared to survey results in 2013 (18).

“As a medical student in Chicago, I was working with some gun violence prevention programs and eager to try and reduce gun violence within the US. However, throughout my career, I have become more accustomed and use to seeing such incidences within the ER,” said Dr. R (pseudonym), MD, an emergency medicine physician in the St. Louis area (personal communication, July 14, 2018).

Increased exposure to gun violence may lead to emotional desensitization as an adaptation or coping mechanism among health professionals, much like gallows humor. However, more studies are needed to confirm this hypothesis.

Many factors contribute to the complex health problem of gun violence. At the individual level, most factors affect early childhood. Some of the strongest predictors of violent activities in later life are early onset aggressive behavior, aggressive cognitive style, early development of pro-aggression beliefs, and social problem-solving skill deficits (6,9). From a social cognitive standpoint, youths with hostile attributional biases overestimate the degree of hostility in a given situation, have poorer behavioral self-regulation, and believe aggressive responses increase one’s self-esteem or masculinity, thereby leading to more aggression and antisocial behaviours (10).

At the interpersonal level, family and peers are key determinants of violence victimization and perpetration. Family dysfunction, single-parent household, family member criminality, poor parenting practices, poor family bonding, poor emotional attachment, high peer delinquency, and low school connectedness are significant predictors of youth violence (6,9,17). In particular, aggressive or delinquent behaviors in later life is often linked to various forms of violence at home that perpetuate intergenerational transmissions of violence through processes like vicarious learning (9,11,12). Since adolescence is a period of self-identity formation mediated by social relationships, one approach is to target adolescent peer groups and role models. Another approach is through strategic peer affiliation, where pairing with a non-aggressive teammate significantly reduce disruptive behavior in aggressive children without putting non-aggressive children at additional risk (13). Combined with attribution modification programs, family involvement and same-age social skills groups during early child development show promise in reducing gun violence. However, more long-term studies are needed to study the effects of such programs on gun violence in later life.

(Clockwise from top left) Abandoned small businesses on Natural Bridge Ave; a diner on Natural Bridge Ave; a child care center on Goodfellow Blvd; a MetroBus stop on Goodfellow Blvd.

At the community level, neighborhood deviance and community violence exposure are significant factors of youth violence, although neighborhood deprivation was not significant in a large-scale factor analysis (6,12). Community violence exposure may further be moderated by social mistrust, social capital, severity of violent activity, and chronicity of violence exposure (7,8). However, causal factors of gun violence at the community level are much more challenging to identify, as perpetrators of violence are often also victims and witnesses of violence. Thus, rather than distinct, sequential events in a causal pathway, community violence exposure and individual violent behavior might be better understood as different representations of a common underlying construct: violence involvement. According to this model, violence involvement predisposes youth to violence exposure, aggressive cognitive style, antisocial peer affiliation, and violent behavior – all of which are components of a broader youth social ecology that involves and/or promotes violence (9).

One intervention that targets all three levels is the St. Louis Area Hospital-Based Violence Intervention Program (STL-HVIP), a large-scale prevention program launched in 2018 by the Institute of Public Health at Washington University in St. Louis and funded by a $1.6 million grant from Missouri Foundation for Health. The key premise of STL-HVIP is that violence exposure – specifically, history of violent injury – is the strongest predictor of violent injury. Hospital-based programs like STL-HVIP leverage teachable moments to instigate changes in the individual-, interpersonal-, and community-level factors of gun violence. Teachable moments are emotionally critical events – such as hospitalization from an injury – where individuals assess the causes, significance, and meanings of such events and subsequently become more receptive to positive health behavior change. Through collaborations with two other universities and four hospitals in the St. Louis area, adult and child victims of gun violence are identified at participating hospitals and will work with trained social workers for up to a year after discharge on their education, employment, housing, mental health, and relationship goals. As a result of STL-HVIP, a repository of regional data will also be generated and used for program evaluations and future research. Hospital-based programs like STL-HVIP have been shown to be highly cost-effective at reducing injury recidivism, medical costs, incarceration costs, and lost productivity associated with gun violence (14,15).

However, there needs to be more policy-level interventions to deliver more permanent solutions to gun violence by addressing the macro-level factors that systematically enable gun violence to affect local communities. In particular, policies that reverse the economic and social turmoil created by St. Louis’ white flight and deindustrialization in the latter half of the twentieth century are needed.

Currently, trends in changes to gun laws in Missouri do not appear to be promising. In 2007, the law requiring background checks and licenses for all handgun owners was repealed in Missouri. The repeal was found to be associated with a twenty-three percent increase in gun homicide rates in Missouri between 2008 and 2012, even after controlling for poverty, unemployment, and other potential confounders; meanwhile, national gun homicide rates have declined (19). In 2014, the minimum age to apply for a conceal-and-carry permit in Missouri was also lowered from twenty-one to nineteen.

“Gun violence does not affect the people in power, who could definitely make a difference in the matter,” said Dr. R, “Honestly, if Sandy Hook and the shooting at Parkland did not change the issue, it will be difficult to sway the people in power to do something” (personal communication, July 14, 2018).

In Missouri, lawmakers who voted for the legislative changes that essentially loosened gun laws represent districts that are ninety-three percent white and forty-three percent rural (20). Clearly, there is a need to engage the communities most affected by gun violence in designing gun violence interventions and policies.

Multifaceted problems require multilevel interventions to be effectively addressed. Since many factors of gun violence are deeply rooted in the formal and informal interactions of affected communities, more legislative changes are needed to catalyze change and create more systematic solutions. While the most recent spending bill in March 2018 includes a clarification on the authority of the Centers for Disease Control and Prevention (CDC) to conduct research on causes of gun violence, many researchers remain skeptical on the future of gun violence research, due to lack of funding and restrictive budget language. Ultimately, gun violence is a major public health issue that we cannot solve without first understanding its nature.

(Clockwise from top left) A woman walks down Natural Bridge Ave; a MetroBus stop sign on Goodfellow Blvd; a grocery store on Natural Bridge Ave; a grocery store in the Wells-Goodfellow neighborhood; an abandoned small business in Wells-Goodfellow.

(Clockwise from top left) A church on Goodfellow Blvd; an abandoned building in Wells-Goodfellow; a grocery store in Hamilton Heights; an abandoned small business in Hamilton Heights.

(Clockwise from top left) A restaurant in Hamilton Heights; buildings and billboards on Natural Bridge Ave; an abandoned house on Goodfellow Ave; a child playing in the West End neighborhood.

Surgery is an integral component of health systems for all countries at all levels of development. It is required across all disease categories, at all stages of life and within all levels of care, from prevention to palliation. In the absence of surgical care, even easily treatable conditions may become fatal. Obstructed labour may result in death for both mother and infant, cleft lip and palate may become an impediment to normal growth and development for a child and a broken bone can lead to lifelong disability.

However, according to the Lancet Commission on Global Surgery, only 6 percent of the 313 million surgical procedures undertaken worldwide occur in the world’s poorest countries, where a third of the world’s population resides. A staggering 5 billion people— largely from poor, marginalized and rural populations— do not have access to adequate surgical care, and an estimated 143 million additional surgical procedures are required each year to prevent death and disability. There are a number of hurdles to overcome: the lack of money, the distance from a hospital that provides surgical care, lack of transportation, lack of medical personnel and lack of infrastructure such as operation theatres, medication, oxygen and blood transfusion. Even among those who do manage to access surgical care, 33 million people face catastrophic expenditures due to the costs of surgical and anesthesia care, while an additional 48 million face disastrous financial burdens that can be attributed to the non-medical costs of accessing surgical care.

Given the changing epidemiological trends in low and middle income countries (LMICs), the burden of infectious disease, maternal disease, neonatal disease, non-communicable diseases and injuries requiring surgical intervention is only projected to increase. Without immediate attention and scale up, the absence of surgical care will not only continue to result in preventable death and disability for millions, but it is also estimated to decrease the gross domestic product of LMICs by as much at 2.0% by 2030. Until recently, intellectual and monetary investment in global surgery has taken a backseat to the priority given to individual diseases in the public health discourse. While remarkable strides have been made in the endeavor of reducing death and disability due to certain conditions, mortality and morbidity due to conditions requiring surgery have increased in the world’s poorest regions, both in real terms and relative to other health gains.

However, the tides are changing. Surgical and anesthesia care has proven to be remarkably cost-effective in resource-poor settings such as in LMICs. According to the World Health Organization’s standards, delivery of surgical and anesthesia services at first-level (district) hospitals is just as cost-effective as other common public health interventions in LMICs such as childhood vaccines, HIV medicines and distribution of bed nets to prevent malaria. (1) Given the enormous economic consequences for both individuals and nations in the absence of access to surgical care and the demonstrated cost-effectiveness of intervention in this arena, surgical and anesthesia care is indeed a sound investment.

Galvanized by the findings and recommendations of the Lancet Commission on Global Surgery, the Program in Global Surgery and Social Change (PGSSC) works to strengthen surgical systems and produce leaders in healthcare systems around the world through research, advocacy and care delivery. The program is a collaborative effort between physicians, surgical residents, medical students and research associates from different countries and backgrounds. These individuals come from a variety of organizations including the Harvard teaching hospitals, the Department of Global Health and Social Medicine at Harvard Medical School, Boston Children’s Hospital and Partners In Health. (2)

According to Shivani Mitra, an alumnus of Washington University in St. Louis, who is currently working at the Boston’s Children’s Hospital under the guidance of oral and maxillofacial surgeon Dr. Salim Afshar, PGSSC functions in a “fast, accurate and efficient way” to correct global surgery inequalities by working on over 50 projects in seven different countries through the public and private sectors. These projects take the form of cataloging the surgical capacities of healthcare systems in different countries and making recommendations for improvement, encouraging policy makers to prioritize increasing availability and access to surgical care in their charters, conducting innovation workshops to involve people from various disciplines and training physician and public health personnel through the Paul Farmer Global Surgery Fellowships and Research Associate positions. Mitra stated that some of their most significant successes and ongoing ventures are the adoption of National Surgical, Obstetric and Anesthesia Plans in Zambia and Tanzania, the evaluation of neurosurgery and trauma care capacities in Haiti and workshops to inspire engineering students to help reduce costs and improve access through technological innovations in India.

In Mitra’s words, “The advantage is that governments are listening to us and we see a good impact, but there are some compliance issues.” Indeed, while momentous headway has been made, it is an uphill battle to challenge the prevailing misconception that surgery is a luxury that only the wealthy can afford. At the dawn of exciting scientific advances such as personalized medicine, gene therapy and robotic surgery, we cannot afford to neglect the millions of people who are dying due to entirely treatable conditions because they are systematically excluded from access to safe, affordable surgical and anesthesia care.

As medicine becomes increasingly specialized, it is more important than ever to train medical students to not only be competent but caring physicians. Nevertheless, many medical ethics courses continue to tend towards presenting impersonal, austere case studies that prioritize taking action and immediate decision making over seeing the patient as first and foremost, a person and not their ailment (5). Hospital culture has also normalized this “professional” detachment; likewise, medical schools now teach students to thrive in an environment where clinical is synonymous with cold and unemotional. This lack of empathy and patient connection may contribute to physician burnout, which is why changes must be made to how medicine is currently taught and practiced. There are a number of innovative programs in the medical humanities that are attempting to bridge the gap between the clinical and the caring.

Physician burnout is on the rise in the U.S, an alarming trend that in part stems from the emotional detachment from patients that medical training can encourage. In medicine, burned-out doctors are more likely to make medical errors, work less efficiently, refer their patients to other providers, and increase the overall complexity and cost of care. In a survey of nearly 7,000 U.S. physicians conducted by Mayo Clinic Proceedings, it was reported that one in 50 planned to leave medicine altogether in the next two years, while one in five planned to reduce clinical hours over the next year (6). What makes the burnout crisis especially serious is that occurs right as the gap between the supply and demand for healthcare is widening: A quarter of U.S. physicians are expected to retire over the next decade, while the number of older Americans, who tend to need more health care, is expected to double by 2040 (6). The competitive numbers that medical schools boast are no guarantee of swelling numbers of future physicians either. Last year, for the first time in at least a decade, the volume of medical school applications dropped by nearly 14,000, according to data from the Association of American Medical Colleges. By the association’s projections, the country may be short 100,000 physicians or more by 2030 (6). With the dearth of healthcare providers, it is more important than ever to address causes of physician burnout.

Imagine you are a third-year medical student, interacting with real patients in a hospital setting for the first time. You are excited to see the science of the classroom be put to work helping people, happy when you find the right answer, sad when you experience your first patient death. You turn to your mentor or your colleague and perhaps they shrug it off, telling you, “You can’t feel for every one,” (4). Humans are often thought to have limited ability to empathize. Based on this logic, allowing oneself to feel for every patient may quickly lead to emotional exhaustion. Therefore, it is conceivable that stunted emotional responses are manifestations of a burnt out state. However, it is also possible that the converse is true. A recent review of literature exploring the relationship between empathy and burnout among healthcare staff suggests that there exists a negative association between the two (4). There was consistent evidence that as empathy decreased, burnout increased, and vice versa. At least some physicians knowingly withhold emotional responses in certain circumstances. However, by neglecting to enter into the suffering of patients and to experience natural human emotions, physicians may not be protecting but actually harming future patients and themselves. Preventing burnout requires a multilevel approach that includes both structural and individual interventions. Ironically, the widely held assumption that emotional engagement leads to burnout may be contributing to the prevalence of burnout within the medical field today.

For many aspiring physicians, the way they are educated encourages detachment from their future patients. This attitude stems from both the general culture in medical school and the way courses involving medical ethics and dissections are taught. The process of emotional detachment for many students begins with first-year Gross Anatomy. In the anatomy lab, students are “introduced simultaneously to the cadaver, death, nudity, and anonymity, and to both the obligation and prerogative to cut and explore the human body, ” (1). Unsurprisingly, it can be an overwhelming and emotional moment for students, but many fear to express these emotions for fear of ridicule from fellow students or teachers. A common response to deal with the unnaturalness of cutting into a human body is gallows humor. Students may invent stories about their cadaver or objectify the bodies for comedic effect in order to distance themselves from the identity of the donor. In 2013, a University of Pennsylvania study examined what is perhaps the most common coping mechanism seen in the lab: cadaver naming. Two-thirds of the medical students surveyed (1,152 from 12 different medical schools) gave their cadavers nicknames, many of them unflattering references to a specific bodily feature (1). “Inventive naming,” the study’s authors wrote, “allows students to acknowledge the cadaver’s personhood, while psychologically shielding themselves enough to be comfortable with the dissection.” However, this coping mechanism can have negative implications for clinical practice later on. They carry this distance and the practice of inventive naming forward on to actual patients. For example, instead of referring to Mr. Jones in room 306, a physician might say, “Let’s go see the terminal in 306,” or “Let’s go see the lung,” referring to the patient as their diseased organ (3). Before they’ve ever walked into an exam room, medical students have already learned from dissection that putting space between the body and the human identity is comforting. In the 1970s, medical sociologist Frederic Hafferty conducted a series of studies on the “emotional socialization” of medical students, concluding that the anatomy lab was “a unique emotional test” where students learned “maladaptive coping strategies in clinical settings,” (2). Instead of suppressing emotions or distancing themselves from the situation, students should be taught how to manage them, which is impossible unless these emotions acknowledge in the first place. The difficulty with anatomy labs in particular is that no one wants to be perceived as weak and will try to suppress their reactions. Thus it is important for instructors to recognize and validate this emotional difficulty. While first-year anatomy labs are an obvious example of the problems with how physicians are educated, they are by no means the only instance of the larger issue.

The attitude of detached concern that anatomy labs encourage is echoed by the overall culture at medical schools as well. In the 1950s, sociologist Robert Merton led a team of researchers at Columbia University’s Bureau of Applied Social Research (BASR) in a large-scale study of the “professional socialization” of medical students. The researchers examined the ways in which doctors’ professional values and behavior were shaped by their training in medical school. The argued that their observations proved that hospitals promoted a distinctly sterile and un-empathic culture and that medical schools trained students to thrive in this environment (2). Stoicism became the litmus test for professionalism, and students felt that their composure was a sign of “progression” in achieving the professional detachment they needed to develop as doctors. However, as time passed, the students in the study began to report they were worried that they were becoming callous or blasé (2). A common sentiment among students was that medical school training worked very hard to beat humanity out of them in favor of professionalism. While academic rigor may be a factor, this phenomenon cannot solely be attributed to the demands placed on students. Equally to blame Merton believes, is what educators now call a “hidden curriculum,” the set of values implicitly instilled in students by their environment. A 2001 Academic Medicine article argued that while medical schools may include lessons on things like listening skills and fostering trust, students are actually learning to value “objectivity, detachment, wariness, and distrust of emotions,” (5). Creating a more empathetic profession is something that requires a long-term solution, one that requires professors to exhibit the values they wish to cultivate in their students.

Many schools are attempting to instill in their students the importance of taking into account the patient’s emotional response instead of only seeing their illness. Physicians have “taught themselves to see this distress and ignore it,” says Jerry Vannatta, a professor of medicine at OU College of Medicine (3). Vannatta teaches a course on narrative medicine, an emerging field that uses storytelling and literature to help physicians learn to better relate to their patients. His students read and write short stories, developing the observational and empathetic skills honed by writing that they will need for the careers. Using comics is also an increasingly popular tool in medical education. Known in academic circles as “graphic medicine,” this approach is part of the field of medical humanities, which emerged in the late 1960s to safeguard medicine’s personal touch (2). Medical humanists argued that medicine’s transition to scientific diagnostics and specialized treatments had jeopardized doctors’ intimate bonds with patients, necessitating new ways to connect with them. Today, American universities have four times as many undergraduate programs in medical humanities—also known as health humanities—as they did in 2000. Many medical schools also incorporate some form of medical humanities into their official curriculum, with courses that explore suffering, resilience, empathy, disability, and death. The classes incorporate visual arts, literature, film, and “pathographies”(stories of illness written by patients or caregivers) into their curriculum. Comics, a newcomer to the field, are an especially appealing way for people to tell their stories of illness. Recent literature has shown how reading these graphic pathographies can be helpful to patients as they navigate illness and the medical system, and also to medical students and practitioners, as they seek to understand the impact of illness on patients beyond the walls of the hospital. Anatomy labs too are attempting to become more broad-minded in terms of the education they provide. Some schools have set up “Donor Luncheons” where the students meet with the family of the donor and learn about their lives prior to the dissection (1). This discourages students from objectifying the body and encourages the students to see the donors as their teachers, in a way. The goal of these kinds of education is to bring to light the realization that patients are more than the sum of their parts, and to teach future physicians must learn to see past physical flesh and bone for the good of both their patients and themselves.

Playing professional football is a dream many aspire towards but few succeed to achieve. After being signed by the Packers as an undrafted free agent in 2015, NFL wide receiver Adrian Coxson had his big chance. Unfortunately, his dream suddenly came crashing down as soon as it began. After suffering a concussion during training camp, Coxson immediately retired, citing a neurologist who told him that one more hit could kill him (1). Concussions have become a recurring factor in football, with around 291 cases reported during the 2017 NFL season. Equally as concerning is the fact that concussions are often unable to be detected accurately. With this in mind, Palo Alto-based company Sync Think has developed Eye-Sync goggles, which are designed to more accurately determine whether a player has suffered a concussion.

While a concussion leads to short-term symptoms such as a temporary loss of consciousness and extreme pressure in the head, long-term effects include the possible onset of Chronic Traumatic Encephalopathy (CTE), a brain disease which leads to toxic Tau protein clumps build up as plaque in the brain, slowly killing brain cells (2). As aforementioned, concussions have become difficult to detect, as the changes it causes in the brain are gradual and not readily apparent. Additionally, Kim Harmon, a sports medicine professor at the University of Washington, states, the reluctance of patients to share their symptoms constrains the ability to diagnose patients, even though “subjective [evaluation] of concussions is most helpful” (3). With the creation of the Eye-Sync goggles, the possibility of patients circumventing the truth diminishes. To check for a concussion, the goggles evaluate a patient’s eye in a circular motion by placing a red dot on the pupil; this shows how the eye “synchronizes with the moving target across two synchronization metrics: radial (or spatial) variability and tangential (or timing) variability” (4). In short, the goggles work to understand the eye’s reaction time to the red dot and whether it can react within a span of 0.25 seconds.

Jam Ghajar, a neurosurgeon by practice and founder of the Sync-Think, says that designing goggles has been his priority for the past fifteen years (5). As the president of the Brain Trauma Foundation, he created SyncThink as a spinoff from the foundation, receiving a staggering $36 million grant from the Department of Defense in addition to $6.7 million in venture capital (V.C.) funding (6). When asked about his goal with Eye-Sync, Ghajar said, “I’m hoping we can really bring down the injury rates of athletes” (7). He added that before Eye-Sync, athletes were being unnecessarily held out of games because of a team’s inability to accurately predict a concussion, (8). With Eye-Sync, Ghajar explains, “Now you test their eye tracking and prediction, and if that’s normal you perform other tests like their balance functions. Everything normal? It’s a migraine. You give them some migraine medication, and they go back in and play” (9).

Since Eye-Sync goggles are gaining more recognition for their benefits, sports organizations, on both the collegiate and professional level, have invested in Eye-Sync as part of the routine health checkups on their players. In 2017, the Pac-12 Conference partnered with SyncThink to ensure that all member universities receive the Eye-Sync technologies to utilize with their Division I athletic programs. In addition to receiving the technology, the Pac-12 selected the University of Colorado at Boulder to be the coordinator of the Pac-12 Concussion Coordinating Unit, working in tandem with SyncThink to record concussion data among Pac-12 schools (10). Universities outside the Pac-12 currently using the technology include the University of Notre Dame, University of Texas at Austin, and Iowa State University.

When asked about the future expansion of Eye-Sync to evaluate more than just concussions, Scott Anderson, SyncThink’s Chief Customer Officer, said that “the long-term value of how teams will use this is as a proactive player management tool” (11). Currently, the Golden State Warriors of the NBA have fulfilled this prediction posed by Anderson, as they use Eye-Sync not only to diagnose potential concussions but to manage fatigue during a strenuous 82-game season (12). Assistant general manager Kirk Lacob said that they plan to evaluate players every 20 games using Eye-Sync and then corroborate the results with the coaching staff to plan scheduled off-days for players (13). Lacob added, “We found that people don’t come into the season rested and ready to go. I think we need to do a better job getting to that point before camp starts” (14).

SyncThink’s next goal is to break into the NFL on the condition that EyeSync deems successful on the collegiate level. As SyncThink CEO Laura Yecies says, “It’s getting pretty ugly out there. It’s becoming very clear that there’s tremendous health impact from health injuries. Something has to be done, and I think we’re giving them a good tool” (15). Yecies claims that they are in talk with the NFL Players Association to implement technology as soon as possible before it’s too late (16). By expanding their bandwidth, SyncThink can hopefully revolutionize the way we look at concussions and give people like Adrian Coxson a way back into the sports they love.

Much of the food we eat today is not at all similar to the food our ancestors ate. Much of what we consume has been genetically altered. Through the combination of biotechnology, genetic engineering, and computer engineering techniques, the range of possible DNA products is greatly increased, thus allowing scientists to change the genetic composition of what we consume. Through the use of synthetic biology, and more specifically, plasmid insertion and DNA editing techniques, scientists have been able to create what we call Genetically Modified Organisms (GMOs). These GMOs are quite controversial, despite the benefits they bring to many individuals.

Take, for example, Golden Rice. Golden Rice is a GMO that possesses the ability to produce beta-Carotene, a precursor of vitamin A. The idea for Golden Rice originated when it was realized that genes in existing crops can be modified, thus giving crops more nutrition or allowing them to withstand adverse climates. There are over one million children who die every year due to vitamin A deficiencies (VAD). Vitamin A is important for vision, the immune system, and reproduction, which is why it is crucial to consume enough of it. VAD is prevalent among poor individuals whose diets are carbohydrate-heavy (2). When individuals rely on rice as a staple food, they are more likely to develop VAD than those who eat a well-balanced diet. This is extremely common in children and pregnant women.

After Golden Rice was introduced to communities with a high prevalence of VAD, it was seen that these individuals began to rely on the GMO as a source for Vitamin A, when it was supposed to be a complementary source of it (2). Foods high in Vitamin A, such as carrots and parsley, are better sources of the vitamin, but many of these individuals assumed that since the rice was modified to produce Vitamin A, there was no need to consume other foods that contain this nutrient. VAD may lead to blindness, so it is crucial for the rice to be consumed solely as a supplement, rather than a staple for Vitamin A. It is not apparent enough that Golden Rice does not eliminate VAD, but rather, reduces it, resulting in debate surrounding its promotion. The crop has great potential, as long as it is consumed alongside other nutritious foods.

Crops do not have to be modified so that their nutritious value is increased; they can be modified to better withstand the environment they are grown in. Whether it be severe weather conditions or pest problems, crops can often be modified in order to combat these issues. Insecticides and pesticides are commonly used to kill bugs that threaten the growth and survival of crops. Some crops are more prone to these pests than others, which is when genetic modification is frequently relied on. Crops can be engineering to express a certain bacterial gene, taste, or scent, thereby reducing the number of pests attracted to that particular crop (3). Often times, the taste or smell inserted into the crop’s genome repels the pests, thus eliminating, or greatly reducing, the need for synthetic pesticides (3).

GMOs are a big topic of debate throughout the world of science. GMOs, just like any organism, are capable of mutating, as the behavior of bioengineered systems is quite unpredictable (4). However, when GMOs mutate, it is often viewed to be the scientist’s fault, rather than biology’s. GMOs may save the lives of individuals, especially when are crops modified so that their nutritional value is increased. On the other hand, the genomes of other crops are altered, removing the need for artificial insecticides. GMOs have great potential, yet their risks have yet to been fully explored. The debate as to whether or not GMOs are safe is ongoing, despite their large presence in our refrigerators and pantries. The next time you take a bite out of something, be aware that it may not be what you think it really is.

You wake up on the ground with blurry vision and feeling nauseous. The last thing you remember is going up for a header – a routine play in a routine match. The trainer runs onto the field and asks some standard questions.

You are taken to the hospital where doctors diagnose you with a concussion. Over the next few weeks, you expect your concussion symptoms of headaches, nausea, and fogginess to begin fading (2). You are told to wait, and then to wait some more. Sometimes symptoms can last for three months. Three months pass; symptoms are still present.

What happens now?

Post Concussive Syndrome or PCS is the persistence of common concussion symptoms past two to three months. It is best defined not as a condition characterized by any unique factors, but as a combination of symptoms including but not exclusive to headaches, difficulty concentrating, and fatigue (4). The condition is characterized by its unknowns like why it affects only certain people and why treatments or so hit-and-miss.

In 2017, after 16 years of monitoring a group of 110 PCS cases, neurological specialists at the University of Toronto and Toronto Western Hospital published a study in The Journal of Neurotrauma titled the “Longitudinal Study of Postconcussion Syndrome: Not Everyone Recovers”. Patients were chosen on the conditions that they had a clean CT, MRI, and TOMM test and if they had concussion symptoms lasting longer than three months. The study focused on diagnostic problems with PCS, the similarity of treatments between those who recovered (REC) and those who did not (NOT-REC), and the implications of not recovering.

The first focus was on diagnostic problems. Doctors have numerous imaging techniques at there disposal. A broken bone can be diagnosed on an X-Ray. An MRI can diagnose muscle damage. But sometimes for PCS there is no imaging technique or key indicator to make an affirmative diagnosis. The normal diagnostic tests – the CT, the MRI, and TOMM testing can return a false negative. The study stated that “PCS is a clinical diagnosis without a diagnostic biomarker” (3). Furthermore, Post Concussive Syndrome can best be mitigated by accurate treatment. But this lack of definitive diagnosis makes precise, evidence-based treatment difficult or impossible and incorrect treatment decisions can lead to the permanence of symptoms.

The symptoms initially presented by the groups – REC and NOT-REC were very similar. This means that making recovery or treatments plans on initial symptoms is impossible. The study tracked the treatments chosen by the two groups looking for differences as indicators to which treatment options are more effective. Both groups underwent the same treatment but only a certain percentage of the participants found any relief. The treatment options included chiropractic manipulation, occupational therapy, physiotherapy, and psychotherapy. The study noted that the NOT-REC group preferred medication whereas the REC group preferred vestibular repositioning exercises. If all external variables are held constant, two patients presenting with the same cluster of symptoms should equally respond to a treatment. The lack of understanding as to why they do not is a grave cause for concern and needs further investigating.

For the NOT-REC group who still faced concussive symptoms the three most exhibited symptoms included headaches, inattentiveness, and fatigue. Additionally, depression occurred in 40% of the NOT-REC group. The study listed thirty-four common persisting symptoms. There was an even spread among somatic, effective, and cognitive symptoms meaning that PCS has an equal effect both mentally and physically. Notable somatic or physical symptoms included neck pain and increased sensitivity to alcohol while affective symptoms included depression and irritability and cognitive symptoms included memory problems, disorientation, and memory difficulties.

The study concluded with a few notable findings. The first being that there was a direct proportionality between the number of symptoms reported and recovery time. Furthermore, many patients suffered from a similar grouping of symptoms. But the most important finding of the study was that PCS is permanent after three years. Of the 110 patients chosen for the model, only 30 subjects became symptom-free. Of these 30 patients, 20 recovered within one year.

The study was innovative in the subset of the patients. But it highlighted a renewed need to understand what precisely happens to the brain during a concussion both mechanically and biologically. It highlights a need to define that key variable – that definable change in the brain. In the meantime, all that can be done is suggesting a band-aid solution to a bullet wound problem All that can be done is treating the symptoms, not the condition. For those afflicted, there is a definite need to redefine how Post Concussive Syndrome is treated.

The air is thick and stifling. Flames leap up the trees and tear through dry brush, fueling them further, and smoke plumes rise high above. This imagery is is likely familiar to most by now, seared into minds with its constant presence in national news and Smokey Bear ads. But days later, and hundreds or even thousands of miles away, pollutants hang in the air, causing numerous unforeseen health consequences such as increased respiratory issues and mortality rates.

Wildfires in the Western U.S. are increasingly common with the decadal averages of large fires increasing and the average wildfire season lengthening significantly over the past three to four decades (1). The vulnerability of forests to large fires has been amplified by lengthened, climate change-induced droughts which weaken trees against pest infestation and, in turn, increase dead tree matter (2).

Wildfire impact can be felt primarily through direct exposure to flames and radiant heat or through indirect exposure to bushfire smoke and combustion by-products, and the water or soil contaminated by them (4). Bushfire smoke, generated largely by the burning of vegetation and wood, features particulate matter as its main air pollutant. Notably, it produces PM2.5 (particulate matter 2.5 micrometers or less in diameter) which can be deposited deep within the lungs and whose increased presence is linked to many adverse health effects including increased mortality. One 2009 study in Finland placed the increase in mortality between 0.5 and 2 percent for each increase of 10 micrograms per cubic meter of urban PM2.5 (5). In contrast, a UK report placed the increase at as high as six percent (4). For bushfire generally, a 2011 study examining mortality rates in Sydney over a 14-year period found that days with high air pollution from bushfires and dust storms correlated with, among other adverse health impacts, a 5% increase in non-accidental mortality (6). Wildfire smoke, and the accompanying particulate matter, can linger for days or even months depending on the scope of the fire, rendering its ill effects all the more troubling (7).

There are also populations whose physiological factors leave them more vulnerable to environmental exposures than others. This includes children, those who are pregnant, and older adults. Children’s greater air intake in relation to body weight as well as pregnant women’s increased respiratory rate increases exposure to air pollutants (7). A lone 2012 study conducted in Southern California also indicated potential of reduced birth weight as a result of prenatal wildfire smoke exposure, which fits into well-documented evidence of low birth weight from exposure to cigarette smoke or ambient particulate matter while in utero (8). In older populations, pre-existing respiratory and cardiovascular diseases may worsen with exposure to wildfire smoke (4).

This latest string of large wildfires in the U.S. easily blends into a backdrop of increased occurrence, intensity, and unpredictability of natural disasters due to the disruption of familiar climate systems. They represent a substantial public health concern as is, and the threat of their damage will only grow with the direction of increased global warming. Mitigating damage from these natural disasters will require proactive scenario planning in the coming decades and calls for greater collaboration and emergency preparation between lawmakers, healthcare providers, and climate researchers.

Remember the last time a mosquito landed on you? While to most people this is a minor inconvenience, to others it is an immense medical threat. According to a 2014 report published by the World Health Organization, 3.4 billion people in the world are at risk for malaria and 2.5 billion for dengue, illustrating the widespread threat posed by vector-borne diseases–diseases transmitted by ticks, mosquitoes, and other insects. Current methods of dealing with vector based disease in regions like Sub-Saharan Africa and South America include insecticide application and treated bednets. However, these techniques are quickly becoming dated and inefficient in the face of growing populations of people and vectors, leading to a new proposition–genetically modified mosquitoes (GMMs). Genetic modification of mosquitoes aims to make mosquitoes sterile to lower reproductive rates or to propagate a gene that reduces disease transmission. While its proponents claim that its effectiveness in field trials and simplicity make it a practical choice for use, others believe that it may have consequences we are not yet fully aware of. GMMs can effectively lower transmission rates of diseases, but have environmental impacts that must be responded to with more research and modification.

One approach to genetically modify mosquitoes is through gene drive, a process defined by immunology and health law professors Ostera and Gostin as “a mechanism to spread [genes] in the mosquito population at a faster rate than would be expected of mendelian inheritance.” . Scientists can spread any particular gene, one helpful in making the mosquitoes less susceptible to becoming vectors of disease, through the population. The results from trials suggest that the model can be a successful choice for disease control, but the technique raises concerns about environmental risk environmental risks, including a reduction in mosquito competition and undesired exposure of the gene to other populations. Epidemiologists in Nigeria found it plausible that GM mosquitoes may spread uncontrollably or hybridize with unknown consequences. Several biologists, in a 2002 study of the ecology of GMMs contend that our lack of complete knowledge regarding disease transmission ecology is the main reason for the concerns regarding possibilities. The reports reveal that the developing status of GMM technology is an issue for implementation, highlighting the need for ecologists to focus on gene flow along with mosquito mating and immigration patterns in order for progress to be made.

Another model for the genetic modification of mosquitoes is the production and release of sterile males into an ecosystem–known as the Sterile Insect Technique (SIT). Several researchers assert that this method will promote lower reproductive rates in a population and stop the spread of the disease. A study conducted by immunologist Megan R. Wise de Valdez and her colleagues (2011), for example, studied SIT and found the model to be effective in lowering reproductive rates and even eliminating a population if necessary. This issue is a concern for many critics of genetic modification, however, who further assert that artificially introducing sterility can be a threat to biodiversity. John D. Mumford, a researcher at the Centre for Environmental Policy in the United Kingdom (2012), points out that mass releases are dangerous because the organisms are able to interact with not only their own habitat, but others as well, causing populations to decrease in unintended regions. This is an issue that cannot be addressed by restricting or isolating ecosystems, since the environment is inherently interconnected. As suggested by several researchers, regulatory laws that ensure proper infrastructure are in place to monitor areas and have become a vital part of SIT use. More systems allowing ecosystem surveillance and the monitoring of immigration and emigration rates are necessary to develop a more concrete basis for implementation of SIT.

After looking at the potential environmental benefits and risks for both forms of genetically modifying mosquitoes, it is necessary to compare GMMs to current tools that minimize vector-borne diseases in developing countries to understand which are more environmentally beneficial. According to one study in 2002, mosquito populations may experience growth after insecticide application is halted. However, treated bed nets cause little pollution and provide a reduction of early contact between mosquitoes and children that greatly diminishes the possibility of contracting malaria. These qualities of existing control methods may make them seem like the better option, but the continual use of techniques like insecticides have led to the creation of resistant populations of mosquitoes. Hassan Mshinda, a researcher at the Ifakara Health Research and Development Centre in Tanzania, along with colleagues Killeen, Mukabana, Mathenge, Mboera, and Knols (2004) compounds the pros and cons by stating that while current control techniques are powerful, they are becoming inefficient when used alone. Mshinda’s research, therefore, supports the idea that implementation of GMMs should be performed alongside current methods rather than completely replacing them.

Using genetically modified mosquitoes to combat deadly vector-borne diseases has been proven to have many positive disease transmission effects, but also presents some considerations regarding environmental risks. As an emerging technology, genetic modification–as well as the ecology of mosquitoes–requires more research before it can be implemented. Most importantly, the environmental impacts and a fear of the unknown effects have concerned researchers and those living in areas where GMM releases are being suggested. (Palmer, 2015). However, the United States Food and Drug Administration (2016) most recently declared a finding of no significant negative environmental impact based on results from a trial in Florida, symbolizing a step in the growth of GMMs towards a safer, healthier society for all. Once results from various studies are synthesized and more trials are conducted in developing regions, the world can implement genetically modified mosquitoes and save lives from deadly vector-borne diseases.

People have wondered what it would be like to face the unimaginable: hearing a physician read off a hopeless list of test results, being forced to make an inconceivable decision regarding intubation and life support, while questioning what their beloved friend or family member would have wanted. Health providers often avoid and families often put off discussing end-of-life care. Yet, death is an inevitable and inescapable reality.

For some people faced with chronic conditions, end-of-life planning and palliative care must be considered with more immediacy. The two most common methods for the official establishment of advance directives or end-of-life decisions are through legal documents, such as a living will, or durable power of attorney. A living will records a patient’s wishes regarding use of medical intervention technology in cases where the patient loses immediate decision-making capability. Advance directive codes like DNR (do not resuscitate) and DNI (do not intubate) make a patient’s wishes clear and preserves their self-determination in moments when they cannot advocate for themselves. A durable power of attorney grants power to a proxy, usually a family member, who then has legal power to act on the patient’s behalf if the patient becomes unable to communicate.

Those with terminal or life limiting illnesses are often informed of these legal options in advance of an emergency situation. The Patient Self Determination Act of 1990 affirmed that advance directives must be a routine part of the hospital admittance process. Even so, for marginalized and minority populations, the importance of end-of-life planning and advance directive completion is often ignored. This oversight is a tragic infringement on human integrity. Dignity in death and equity in self-determination should be accessible for all.

An example illustrates the issue in action: a 98-year-old woman arrives at an emergency room with no advance directive. In this situation, the legal responsibility of physicians is to resuscitate her at all costs. While they manage to save her from dying, she very well may also be spending her last moments unable to walk, talk, eat, or communicate with loved ones. Would this woman in her late-nineties have wanted to be intubated, spending her dying moments immobilized and powerless? Perhaps not. However, the moment this patient arrived through the hospital doors without legal documentation about her end-of-life desires, she no longer had autonomy in this decision.

While more than 25% of Medicare beneficiaries have not submitted any official legal advance directives, a study has shown that the medical field’s neglect of marginalized communities are more grave that this statistic alone. The detailed analysis concluded that minority and marginalized groups are at a greater risk for not even having a advance care planning discussion with their healthcare provider, which is the legal minimum for all patients.

A study funded by the Center for Disease Control and done by Dr. Krista L. Harrison et al (2016) used data from the National Health and Aging Trends Study (NHATS) incorporated three self-report measures that detailed the extent of their advance care planning conversation. The study also included concrete initiatives toward filing an advance directive. The 65 and older participants were asked the following questions: 1. If they had discussed the medical treatment they wished to have if seriously ill in the future, 2. if they had any legal arrangements for a surrogate decision maker in an emergency, or 3. if they have formal written instructions about medical treatment desired if incapacitated (1).

Age, sex, race/ethnicity, and income were used as subgroup characteristics for further analysis. Four subgroups had significantly different results then the average (2). The study identified Latino, African-American, low-level of education, and low-income patients as communities that have a higher risk for not only failing to file an advance directive, but not having an end-of-life conversation.

Another study done led by Ivy A. Huang (2016) (3) builds upon this research through considering how religious affiliation and personal health values may affect these results. Religious groups may advocate for specific end-of-life decisions, and personal health values vary along with race and ethnicity. Even accounting for these as potential confounding variables, African-American populations are at a greater risk for not possessing an advance directive; African-Americans are also almost half as likely to have a living will or power of attorney (4).

Additionally, studies show that one size does not fit all when it comes to end-of-life planning. Past research documents the difference between end-of-life care preferences between ethnic groups. African American and Latino populations report desires for more aggressive care interventions and life extending options over comfort-care, compared to Caucasians (5).

Discrepancies as large as these cannot be explained as a mere coincidence. These studies highlight a particularly alarming derivative of broader healthcare inequality. We know that comprehensive healthcare is not even-handed. There are systemic inequities that have deep rooted historical origins. Yet, people often fail to consider that these discrepancies persists all the way to decisions on death. Although the U.S considers a human death as worthy of respect, the U.S healthcare system does not make this standard accessible for all groups. By not extending end-of-life conversation to marginalized communities, our healthcare system is implicitly asserting that certain privileged groups are more deserving of autonomy than others in their final moments. This disparity in end-of-life autonomy exhibits the extent that healthcare discrimination reaches.

Efforts must continue to make end-of-life discussion a priority in patients with chronic illness. In addition, health providers of end-of-life care must consider a patient’s health-literacy and revise the current conversations to each individual’s specific level of understanding. No individual faced with an already painful situation should be stripped of their autonomy simply due to their minority status. Death is a fundamental part of existence; it should be fundamentally dignified for all as well.

With what seems to be an endless midterm season, I often find myself dragging my feet to Olin library, the only place I’ll ever get my work done. As soon as I settle into my chair, I put in my earphones and turn on my Spotify playlist. Looking around my surroundings, I see that my peers have done the same — there are rows of students listening to music, plugged into their earphones, completely absorbed in their studies. Music surrounds us all the time, from the fifteen minute bells that ring throughout the school to that tune your friend keeps humming over and over again while walking to class with you. Despite how routine and ordinary music may seem, it actually carries great potential and power for clinical applications as a form of healing and repairment.

These applications are part of a field called music therapy. According to the American Music Therapy Association, music therapy is the “clinical and evidenced-based use of music interventions to accomplish individualized goals within a therapeutic relationship…to address physical, emotional, cognitive, and social needs” (1). Music therapy can take effect in very extensive and individualized forms, allowing the therapist to accurately assess and provide specific treatment for each client. Treatments include a range of music-related activities such as “creating, singing, moving to, and/or listening to music” (1).

Music therapy, as it so happens, also has roots that reach far into the past. Ancient Greeks characterized “music as therapeutic… reflecting and projecting the harmony of the cosmos onto the mind and thus creating or reestablishing inner harmony.” During the 18th century, German physician and chemist Ernst Anton Nicolai wrote about the “affective effect of music on the mind and soul which… will influence the physical-physiological state of the body” (2). More recently, music therapy was established as a profession in the 20th century “after World War I and World War II when community musicians… went to Veterans hospitals around the country to play for thousands of veterans suffering both physical and emotional trauma from the wars” (3). With the establishment of the profession, people with developmental and physical disabilities, elderly people in nursing homes, handicapped children, and prisoners became clients of music therapy.

With the increasing prevalence of music therapy, researchers have observed patterns improved social interactions and wellbeing that come with the benefits of music therapy. Although, concrete neurophysiological effects of music therapy are seldom recorded because the effect of music therapy differs from person to person, recent literature suggests that music therapy for people who are affected by reduced white matter structure can prove effective and increase neuroplasticity.

The most common technique in studying and analyzing structural properties of the brain’s white matter is diffusion tensor imaging (DTI). This method “measures the characteristics of diffusion of water molecules in brain tissues” to measure “biological features, such as axonal size, density, coherence and degree of myelination [which] all constrain water molecule motion” (4). Researchers primarily use voxelwise fractional anisotropy, a measurement that exhibits directional movement of water molecules, to analyze the brain’s white matter. Uniform movement of water molecules through axons produces high fractional anisotropy values, whereas random movement of water produces low FA values, suggesting abnormalities (5).

With recent literature on white matter structures and connectivity within the brain, music therapy has become increasingly prevalent in improving the wellbeing people affected by various mental conditions such as dementia and autism spectrum disorder. For instance, autism spectrum disorders involve structural deviations from the brain’s white matter. Recent research has elucidated the presence of biomarkers that indicate physiological and biological abnormalities in autism spectrum disorder. Many studies have associated decreases in volume, fiber connections, and fractional anisotropy with autism spectrum disorder (5). One such study has shown that abnormal development of white matter pathways found in infants of less than a year of age are at high risk to develop ASD by their second year (6). Scans from people with ASD indicate lack of neural connectivity in areas essential for cognitive skills such as motor function, language, and social behavior. Research findings that relates autism as an impairment in connectivity corroborates the effectiveness of music therapy and suggests potential neuroplasticity and new wiring in white matter structures.

From a study that involved 23 healthy children completing 9 months of music training using percussion tubes, Dr. Dies-Suarez, the chief radiologist at Hospital Infantil de México Federico Gómez in Mexico City says, “these tasks involve hearing, motor, cognition, emotion and social skills, which seem to activate…the need to create more connections between the two hemispheres of the brain” (5). Active music therapy, in which patients themselves get to partake in creating music, stimulates and exercises the part of the brain involved in motor functions and cognitive skill demonstrated by increased connectivity white matter connectivity.

A study of white matter structure and its association with autism spectrum disorder and attention-deficit/hyperactivity was conducted by Dr. Yuta Aoki at the department of Child and Adolescent Psychiatry at NYU Langone Medical Center. DTI data was analyzed from 174 children and focused primarily on the corpus callosum. DTI results showed that there were abnormal diffusivity resulting “lower fractional anisotropy, along with greater mean diffusivity and radial diffusivity, in multiple corpus callosum regions both characterized ASD diagnosis, as well as ASD traits across children” (7). When compared with a study that observed the neuroimages of experienced dancers and musicians, musicians showed “increased coherence of effector specific-fibre pathways” in the right hemisphere (4). The two studies, in comparing white matter structure in the corpus callosum, show that music training may stimulate increased fiber pathways near the corpus callosum. Although we cannot definitively correlate the two studies to prove that music therapy yields to increased white matter structures, the studies suggests that white matter structure is an essential part of neuroplasticity.

Music therapy has far-reaching influences for people living with dementia. Recent research on the effect of music on the human brain has brought further insight on the way music therapy affects social behavior, cognition, and memory. According to 2018 statistics from Alzheimer’s Association, Alzheimer’s is the sixth leading cause of death in the United States. Music therapy can serve as a non-pharmacological and cost-effective way to improve the wellbeing of people living with dementia (8). Musical intervention for various dementia cases prove to be associated with biography of the individual. Therefore, it is quite important for music therapy to incorporate individualized music to evoke a personal experience and facilitate communication between family members and friends.

In a study that investigated the effectiveness of music therapy patients using endocrinological and behavioral evaluations, ten patients with senile dementia, six with Alzheimer’s, and four with vascular dementia were evaluated for eight consecutive weeks of music therapy using music that was familiar to patients. The researchers evaluated subjects on a standardized test for ‘irritability’ and collected salivary chromogranin A (CgA), a protein that was used as a biochemical marker of stress, from the twenty individuals (9).

The results showed a significant decrease in irritability after eight weeks of the music session. In the case of an 86-year old male patient with vascular dementia. Before the music intervention, he demonstrated confused and agitated behavior, including “hitting or scratching the nursing staff… not taking initiative or speak voluntarily,” but after the eight weeks of therapy, “his agitated behavior at night-time decreased, hitting and scratching while the nurses were changing his diaper decreased” (9). On the 16th session, his levels of CgA before music intervention was 1.903 ρmol/mL and 0.837 ρmol/mL after. Similar results were obtained for the other patients.

This study suggests that musical intervention is effective in decreasing irritability and stress levels, as shown by the CgA levels, among people living with dementia. This also suggests the power and importance of music in a clinical setting. Cognitive stimulation using music produces substantially positive effects on the wellbeing and mood of dementia patients.

The previous study utilized music that the patients closely associated with. Similarly, in a review written by Dr. Steve Matthews, “Dementia and the Power of Music Therapy,” Matthews describes the case of Henry and how music therapy restored his narrativesocial agency, the ability to recognize close relationships and aspects of self, like favorite activity or favorite song. Henry is described as an elderly man with severe dementia, idle, unresponsive, and unable to recognize his daughter. When exposed to his favorite song, Henry entered a “period of animation and cognitive awakening” (10). After listening to the music, Henry states, “I’m crazy about music… Cab Calloway was my number band guy I liked… It gives me the feeling of love, romance” (10). In a response to Henry’s case, Oliver sacks, renowned neurologist and author, remarks, music seem “to touch springs of memory and emotion which may be completely inaccessible to them” (10).

In Henry’s case, music therapy ignited a part of his heart and soul that allowed him to recall a part of himself that was lost from dementia. Even though music therapy cannot cure Henry’s disease, music therapy reconnected him with his love music and dancing. As I finished reading Henry’s case, I looked up from my laptop. Same people, sitting in rows, plugged into their music, quietly studying for their midterms. I couldn’t help but think, music is about self-care. It’s about healing. It’s about remembering. It’s about feeling. Music and emotion married into a sweet phrase, speaking to our aspirations, our despair, and our triumphs, has incredible ways of working within our lives.